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House Leaders Plotting Health Bill Endgame

There’s no end in sight for the health care debate in the House, and behind the scenes, Democrats are pointing their fingers at the Senate Finance Committee’s slow pace, the White House’s lack of guidance, and their own Caucus’ warring factions for the delays.

House Democrats feel that they are tantalizingly close to finalizing their bill — with a goal of sending it to the Congressional Budget Office this week. But House Majority Leader Steny Hoyer (D-Md.) warned it will be at least a few more weeks before a bill comes to the floor.

Aides say the House’s deliberations slowed because many Members wanted to see what emerged from the Senate Finance Committee before making commitments. And some complain that the White House has refused to get its hands dirty after President Barack Obama came to Congress to deliver his health care address last month.

In the meantime, Speaker Nancy Pelosi (D-Calif.) has been loath to commit publicly to any specifics beyond saying that some form of a public insurance option will be in the House bill, as she faces a fractious Caucus that seemingly spawns a new subgroup every week demanding that something be either included or excluded from the bill.

“We’ve got a Caucus who, on dozens of issues, people have drawn some lines in the sand,— one Democratic leadership aide said.

That has Democrats struggling to meet competing goals. They are trying to meet the Obama administration’s call for a bill costing about $900 billion over 10 years for the insurance portion of the bill, which is about $150 billion cheaper than the original House version. But other Members are demanding that the bill avoid using Medicare rates for a public insurance option, which would cost tens of billions more. Liberals, meanwhile, continue to whip Members to oppose any bill not tied to Medicare.

House leaders also have entertained the idea of taxing high-cost insurance plans, which the Senate Finance Committee does — and which could help them shrink a $544 billion surcharge they have proposed on the rich.

The two taxes have spawned competing letter-writing campaigns. Rep. Joe Courtney (D-Conn.) launched the latest salvo, sending a letter last week signed by 107 Members opposing the tax on high-cost insurance plans as hurting the middle class. An earlier letter led by freshman Rep. Jared Polis (D-Colo.) opposed the surcharge on the rich as falling too heavily on small businesses.

The insurance tax would hit more people in high-cost states like Courtney’s and violate pledges not to tax the middle class. Courtney said he had assumed the idea was dead in the House, until it recently came up in Caucus meetings.

“Like some horror movie it’s started to show signs of life, coming back from the dead,— Courtney said.

Courtney said the tax also doesn’t make sense politically. “The Republican Party will be ruthless, I think, in using that as an attack item,— he said.

Some Democrats expect the insurance idea to be dropped for now, with the surcharge scaled back so it only affects millionaires.

Courtney, meanwhile, said he doesn’t expect a bill to be finished anytime soon.

“They are trying to find the sweet spot here to get 218 votes,— Courtney said. “We still have many weeks to go before we find that sweet spot.—

Democrats also complain privately that the White House hasn’t done much to help the House slice its bill to $900 billion and help get votes. Some believe the White House is holding back on potential additional savings — either from drug companies or elsewhere — as a hole card.

“We know that’s what’s going to happen in the end,— one leadership aide said. “They are going to come out with a rabbit in the hat during conference, and we will have already taken a tough vote.—

Other Democrats are increasingly nervous that the bill must do more to improve the insurance market before 2013, when a national insurance exchange for the uninsured is scheduled to begin.

“There is a giant problem with the fact that nothing happens until 2013 and there are two elections in the intervening years,— the aide said.

Majority Whip James Clyburn’s (D-S.C.) proposal to include state pilot programs sooner has gained traction, although how that would be accomplished and funded has not been resolved.

There also was fresh evidence that vulnerable House Democrats remain restless with their top brass as the politically treacherous vote on the package looms. On Thursday, Rep. John Barrow (D-Ga.) defied pressure from leadership and endorsed forcing a vote on a new requirement that House bills get posted publicly 72 hours before floor consideration. He was the sixth Democrat to join 176 Republicans on the petition.

Tory Newmyer contributed to this report.

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